Association between vasopressin administration and mortality in patients with cardiogenic shock.

Background: The utility of vasopressin as an adjunctive, catecholamine-sparing vasopressor in cardiogenic shock (CS) has not been widely examined.

Methods: We included consecutive adult patients admitted with a diagnosis of CS requiring vasopressors. High-dose vasopressors (HDV) were defined as ≥0.3 mcg/kg/min of norepinephrine equivalent. Multivariable logistic regression and propensity analysis was used to calculate odds ratio (OR) and 95% confidence interval (CI) values for in-hospital mortality, before and after adjustment for relevant covariates.

Results: We included 721 CS patients, including HDV in 32.5%. Vasopressin was administered in 207 (29%) patients within the first 24 hours. In-hospital mortality occurred in 38.1% and was higher in the HDV group (56.8% vs. 29.2%). Vasopressin was associated with lower propensity adjusted in-hospital mortality (adjusted OR 0.59, 95% CI 0.35-0.99, p = 0.05). Vasopressin use was also associated with lower mortality in the HDV group (unadjusted OR 0.54, 95% CI 0.32-0.92, p = 0.02).

Conclusions: Vasopressin use in the first 24 hours was associated with lower adjusted mortality in patients with CS, particularly amongst those requiring HDV. The use of vasopressin in CS merits dedicated prospective evaluation.